Infectious disease

Question 1

What is sepsis

Answer 1

Significant immune response causing widespread inflammation

Question 2

In sepsis, what happens to the

Body fluid compartments

platelets

Blood lactate

Answer 2

Oedema due to increased capillary permeability

Thrombocytopaenia due to coag activation

Raised lactate due to hypoperfusion

Question 3

What constitutes septic shock?

How is it treated

Answer 3

Systolic <90mmHg

AND/OR

Lactate >4mmol/L

Admin of inotropes in HDU (NOT FLUIDS)

Question 4

Regarding observations in sepsis…

What is the first sign

How do they differ in neutropaenic sepsis?

Answer 4

Raised RR is the first sign

Neutropaenic patients have normal temperature

Question 5

What are the take 3 give 3 of sepsis?

Answer 5

Take 3

Blood lactate

Blood culture

Urine output

Give 3

Oxygen

IV antibiotics

IV fluids

Question 6

What lab finding would point towards neutropaenic sepsis?

Answer 6

Neutrophil count <1 x 10^9

Question 7

What makes up the CURB65 score in pneumonia?

Answer 7

Confusion

Urea >7mmol

Resp rate >=30

Blood pressure <90 sys OR <=60 dia

65+

Question 8

What are the two most commmon causes of CAP?

Answer 8

1. Strep pneumoniae (G-ve, a-haem strep)
2. H. Influenzae (G+ve, aerobic bacilli)

Question 9

What are the 4 most common atypical CAP causes and their associations

Answer 9

Legions of psittaci MCQs

Legionella: cheap holiday, low sodium

Chlamydia psittaci: From birds

Mycoplasma pneumoniae: Target lesions, neuro features

Chlamydia pneumoniae: school aged kids with wheeze

Q-fever (coxiella burnetti): Farmer with flu symptoms

Question 10

What pathogen is associated with pneumonia in…

Immunocompromised or chornic lung disease

Cystic fibrosis

Cystic fibrosis and bronchiectasis

Answer 10

M. Catarrhalis

S. Aureus

P. aeringuosa

Question 11

What pneumonia bug do the following get

Immunocompromised patients

Alcoholics

Answer 11

Pneumocystis jiroveci

Klebsiella

Question 12

How do you treat

Mild-mod CAP

Severe CAP

Non severe HAP

Severe HAP

Pneumocystic pneumoniae

Answer 12

5 days Amox (dox + macrolide)

PO Co-amox + dox (levofloxacin)

PO Amoxicillin (Doxycycline)

IV amox + gent (co-trimox + gent)

Co-trimoxazole, can be given prophylactically

Question 13

How can you differentiate between lower and upper urinary tract infections?

Answer 13

Lower: Dysuria, incotinence; confusion in older patients

Upper: Fever, loin pain, haematuria

Question 14

What testing should be performed in a suspected UTI?

Answer 14

Dipstick for nitrites and leukocytes

MSSU for culture

Question 15

What is the most common cause of UTI?

Answer 15

E. Coli (G-ve, anerovic rod)

Question 16

What is the management of the following UTIs

Lower UTI in

Males

Non-pregnant

Pregnant

Upper UTI

Answer 16

Males: Nitro/trimethoprim 7 days

Non-pregnant: Nitro/trimethoprim 3 days

Pregnant

asymp: nitro/amox/cefelexin 7 days
symp: 1. Nitro 2. Amox/cefaxelin 7 days

Upper: Co-amoxiclav/ Co-trimoxazole 10–14 days

Question 17

When are the following antibiotics avoided in pregnancy for UTI and why?

Nitrofurantoin

Trimethoprim

Answer 17

3rd trimester due to haemolytic anaemia in newborns

First trimester to tue neural tube defects

Question 18

What are the 3 most common causes of cellulitis?

What is the other cause to be aware of?

Answer 18

S. aureus

group A strep

Group C strep

MRSA

Question 19

What antibioitic is given for cellulitis?

Answer 19

Flucloxicillin

Question 20

What is the most common cause of tonsilitis, otitis media and rhinosinusitis?

Answer 20

VIRAL

Question 21

What are the two most common bacterial causes of tonsilitis, otitis media, sinusitis?

Answer 21

Strep pyogenes

Strep Pneumoniae

Question 22

When is antibiotics given for tonsilitis?

What do you give?

Answer 22

CENTOR >=3 OR FeverPAIN >=4

Phenoxymethylpenicillin (Pen V) for 10 days (clarithromycin otherwise)

Question 23

What indicates otitis media and when would you consider antibiotics?

Answer 23

Painful ear with bulging tympanic membrane +/- discharge if perforation

If >3 days, under 2yrs, discharge or systemic infection

Question 24

What is the first line treatment for otitis media?

Answer 24

Amoxicillin PO 5 days (clarithromycin)

Question 25

How does duration of symptoms dictate sinusitis antibiotics?

Answer 25

\<10 days: no therapy \>10 days: trial 2 weeks high dose nasal spray + if \>10 days and likely bacterial cause: Pen V (clarithromycin)

Question 26

What are the two broad bacterial groups causing intra-abdominal infection

Answer 26

Coliforms (E. Coli, Klebsiella, enterobacter) Anaerobes (bacterioides, clostridium)

Question 27

What regime is used in Tayside for intra-abdominal infection?

Answer 27

Amoxicillin (+ves) + Metronidazole (anarobes) + Gentamicin (-ves) Replace amox with vanc if allergic

Question 28

In Tayside, what is used for the following SBP infections Mild Severe

Answer 28

Co-trimoxazole PO Piperacillin/tazobactam then Co-trimoxazole

Question 29

What should you do for a red, hot, swollen joint with reduced mobility?

Answer 29

Aspirate to for microbiology to exclude septic arthritis

Question 30

What is the most common cause of septic arthritis?

Answer 30

S. aureus

Question 31

What should you suspect in younger patients with septic arthritis?

Answer 31

Gonococcal infection if sexually active

Question 32

What is the treatment of septic arthritis

Answer 32

Empirical until sensitivities back Usually flucloxicillin

Question 33

What are the causes of viral gastroenteritis?

Answer 33

Rotavirus Norovirus Adenovirus

Question 34

Name the pathogen that fits the gastroenteritis history Pork, 4-7 days incubation, children with lympahdenopathy Uncooked rice, IVDUs, 8hr incubation; vomiting 5hrs, diarrhoea 8hrs, resolution 24hrs Unwashed salad or water, antibiotic use, + blood Water, pools and food, 1-2 days incubation Raw eggs and poultry; 12hr-3d incubation, watery+/- mucus, blood Travel, uncooked poultry, water; 2-5 days incubation, + blood

Answer 34

Yersinia Bacillus Cereus E. Coli Shigella Salmonella Campylobacter jejuni

Question 35

What is the general approach for gastroenteritis?

Answer 35

Send stool for MCS Fluid challenge +/- oral fluids Generally avoid antidiarrhoeals and antiemetics Isolate for 48 hours post-symptoms

Question 36

What are the common causes of bacterial meningitis in Adults and children Neonates

Answer 36

N. meningitidis, S. pneumoniae GBS

Question 37

What can help clinically identify meningitis in Adults and children Newborns and infants

Answer 37

Straighten knee with flexed hip (Kernig) or put chin to chest (Brudzinkis sign), will cause resistance or pain Perform LP... \<1 month + fever 1m-1yr: Fever + unwell

Question 38

What is the typical treatment for bacterial meningitis if In community Hospital

Answer 38

Community IM benpen (\<1yr: 300mg, \<9yr: 600mg, \>=10yr: 1200mg) Hospital \<3 months: Cefotaxime + amoxicllin (cover listeria) \>3 months: Cetriaxone + Vanc if travel, long term therapy + Dexamethasone if \>3 months 4 x 4 daily

Question 39

Who else gests treated following a suspected meningitis case and what is given?

Answer 39

Close contacts in past 7 days Single dose ciprofloxacin

Question 40

What are the common causes of viral meningitis?

Answer 40

HSV Enterovirus VZV

Question 41

What is the most worrying form of malaria?

Answer 41

Plasmodium falciparum

Question 42

Outline malarial transmission

Answer 42

Infected blood --\> Anopholes mosquito --\> sporozites in gut --\> infection to human --\> travel to liver to infect RBCs

Question 43

Why do malaria patient have pallor, jaundice, hepatosplenomegaly and 48hr fevers

Answer 43

Travel to liver, infect RBCs, cause them to rupture then further infect

Question 44

How do you diagnose malaria?

Answer 44

3 samples over 3 days in EDTA for malaria blood film

Question 45

How do you treat the following malaria forms Uncomplicated falciparum Severe falciparum Non falciparum

Answer 45

Uncomplicated: ACT combos -will be 'arte' plus another drug, Quinine + doxy/clinda Severe: IV artesunate if \>2% count, exchange transfusion if \>10% Non-falciparum: Chloroquine